|
#16
03.09.2005, 15:48
|
|||
|
|||
|
1. As reviewed by Taylor (2000), ACEI renography is highly accurate in patients with a moderate likelihood of renovascular hypertension and normal renal function, wherein sensitivity and specificity are approximately 90%. By сombining data from ten studies that evaluated the effects of revascularization in 291 patients, the mean positive predictive value of ACEI renography was 92%. As expected, the test is less sensitive in patients with renal insufficiency; as many as half will have an indeterminate test. In a subsequent metaanalysis of 14 studies, ACEI renography provided diagnostic accuracy similar to ultrasonography ( Vasbinder et al., 2001).
2. The test may give false-negative results in some patients with small ischemic kidneys and evidence of unilateral disease when bilateral disease is present ( Scoble et al., 1991). Источник: Kaplan's Clinical Hypertension 8th edition (March 15, 2002): by Norman M. Kaplan, Ellin Lieberman (Contributor), William Neal (Editor). Есть в наличии pdf версия, если надо. 
|
|
#17
03.09.2005, 15:56
|
||||
|
||||
|
Цитата:
|
|
#18
03.09.2005, 16:09
|
|||
|
|||
|
Цитата:
Because hypersecretion of renin from the hypoperfused kidney is the primary event in the pathogenesis of RVHT, it came as no surprise that increased peripheral PRA levels were found in patients with the disease. However, subsequent experience with PRA assays in peripheral blood showed that many patients with RVHT did not have elevated levels (Rudnick and Max-well, 1984), in keeping with the experimental evidence that secretion of renin from the clipped kidney falls to “normal” soon after RVHT is induced, whereas renin release from the contralateral kidney is suppressed. 2. Captopril-Enhanced Peripheral Plasma Renin Activity Various maneuvers have been used to augment PRA release in the hope that patients with curable disease would show a hyperresponsiveness, thereby improving the discriminatory value of peripheral levels ( Wilcox, 2000). Of these, the response of PRA to captopril has been most widely used ( Muller et al., 1986). Subsequently, a high rate of false-positive captopril renin tests was noted in patients with baseline high PRA levels ( Gerber et al., 1994). The criteria for a positive test have been lowered; Wilcox (2000) uses a postcaptopril PRA level in excess of 5.4 ng per mL per hour. Whatever the criteria, the test has been found to have limited value as a screening study (Vasbinder et al., 2001). 3. Comparison of Renal Vein Renins The comparison of renin levels in blood from each renal vein, obtained by percutaneous catheterization, has been used to establish both the diagnosis and surgical curability of RVHT since the initial report by Helmer and Judson (1960). In most series, a ratio greater than 1.5:1.0 between the two renal vein PRA levels was considered abnormal, or lateralizing. An abnormal ratio was 92% predictive of curability; however, 65% of those whose renal vein PRA level ratio did not lateralize also were improved by surgery (Rudnick and Maxwell, 1984). This procedure cannot be used as a screening test, but it may be useful in confirming the functional significance of a lesion demonstrated by arteriography, particularly if bilateral disease is noted. However, the captopril renogram will serve that purpose in addition to providing a more reliable screening test. Therefore, renal vein renin measurements are being used less and less.
|
|
#20
03.09.2005, 16:21
|
||||
|
||||
|
Цитата:
plyas (собака) samaralan (точка) ru
|
|
#21
03.09.2005, 16:54
|
|||
|
|||
|
Цитата:
|
|
#24
12.09.2005, 10:56
|
||||
|
||||
|
Продолжаю.
По УЗИ: правая почка 8,7*3,4, левая 9,6*4,1, паренхима 11-13 и 13-15 мм. соответственно, повышеной эхогенности, в правом почечном синусе киста 1,5 см. Сцинтиграфия (на фоне приема 50 мг. каптоприла): снижение почечного кровотока с обеих сторон симетричное на 10-15 %, симетричное незначительное снижение экскреции.
|
|
#25
12.09.2005, 11:30
|
||||
|
||||
|
Цитата:
|
|
#26
12.09.2005, 13:19
|
||||
|
||||
|
Цитата:
 , нет технической возможности. А ренография была одна.
|
|
#27
12.09.2005, 13:42
|
||||
|
||||
|
Цитата:
Ну тогда выходит - односторонее поражение маловероятно, а двухсторонее вообще этим методом исключить нельзя. Яна, думаю, точнее скажет. А вообще воду давали перед исследованием? Медикаменты перечисленные не принимал пациент? Это важно, иначе чувствительность снижается.
|
|
#28
12.09.2005, 17:39
|
||||
|
||||
|
Цитата:
|
|
#29
12.09.2005, 19:02
|
||||
|
||||
|
Поскольку у радиологов давным давно накрылся принтер, то картинки на руки не дают. Завтра схожу посмотрю на экране.
Все, что написано в истории болезни: Т макс слева 3' справа 3'. Т1\2 соответствено 26' и 28'. Насколько могу догадываться, имеется в виду время достижения максимума активности и время полуспада ее. 
|
|
#30
12.09.2005, 19:17
|
||||
|
||||
|
Т макс - время максимальной визуализации (time to peak cortical activity). Абсолютно правильно догадались.Три минуты - отличное время. Лучше не бывает. Т1/2 - какое-то странное (я бы его назвала временем полувыведения). Великовато.
Посмотрите у них на экране максимальную активность (по оси игрек - пик кривой) и активность через 20 минут от начала кривой (время соответственно по оси Х). Вторая активность должна быть где 30% первой. А разница в относительной функции почек не больше десяти, то есть от 50%/50% до 55%/45%. Но в принципе, если пик у обеих почек - 3 минуты после каптоприла, вазоренальная гипертония очень сомнительна.
|
Линейный вид
